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Background: Surgery in pancreatic cancer remains the curative option, consequently drawing attention to the importance of an indeterminate group of patients potentially curable by undergoing this procedure, Borderline Resectable Pancreatic Cancer (BRPC). Despite this seemingly positive outlook the outcome of these patients remains undefined. Aim: To assess the response of BRPC patients to neoadjuvant treatment and the accuracy of radiological constraints in their selection. Methods: Data extraction from a university hospital filing system from September 2015 to September 2018 was performed to select patients with BRPC. The National Comprehensive Cancer Network (NCCN) criteria to define BRPC were used. Clinical, surgical and radiological parameters were collected pre/ post-operative for all cases and correlated to outcome. Results: Sixty patients with BRPC were identified. The outcome of neoadjuvant treatment was partial response in 6 (10%) patients, stable disease in 49 (81.7%) and progressive disease in 5 (8.3%). The majority (78.3%) of patients underwent pancreatectomy. In patients who underwent resection a median overall survival of 31 months (95% CI: 29.180 - 32.820) was achieved vs. 17 months (95% CI: 15.625 - 18.375) in non-resected cases (p < 0.001). Response to neoadjuvant therapy was found to be favorable for overall survival (p = 0.014) and progression-free survival (p = 0.006). Response Evaluation Criteria in Solid Tumors (RECIST) criteria did not predict operative potential. Conclusion: RECIST criteria lacked predictive potentiality for surgical intervention after neoadjuvant chemotherapy in a cohort of BRPC patients. The significant positive outcome observed in BRPC patients who underwent surgery emphasizes that the decision for this procedure should not depend on the response to neoadjuvant treatment per se.

The Role of Radiological Parameters in Assessing Response to Neoadjuvant Therapy in Borderline Resectable Pancreatic Cancer